As many as 1 million Americans live with Parkinson's disease, a brain disorder that may lead to tremors, stiffness and difficulty with walking, balance and coordination. Although an estimated 60,000 Americans are diagnosed with Parkinson's each year, thousands of cases go undetected.

Symptoms of Parkinson's disease usually begin gradually and worsen over time. Common early warning signs include tremors or shaking; trouble moving or walking; stooping or hunching over; and a soft or low voice. Many patients in the early stages of the disease think their symptoms are due to normal aging and do not seek help from a doctor.

Once patients do seek help, diagnosis can be difficult. There are no medical tests to diagnose Parkinson's with certainty, and many other conditions may produce similar symptoms. Once it is confirmed that a patient has the disease, it is important that they begin therapy as soon as possible.

"Our Rehabilitation Center works directly with doctors to get referrals as soon as patients are diagnosed," says Pamela Singh, physical therapist at Sharp Grossmont Hospital. "This increases the likelihood that the treatment will slow progression and decrease symptoms of the disease."

New patients are tested for strength, balance, coordination, speed and quality of walk, and other criteria. From there, therapists develop an individualized treatment plan. Therapists at Sharp Grossmont are trained in three core treatment approaches for Parkinson's disease:

PWR! (Parkinson Wellness Recovery): A customized program that teaches Parkinson's-specific exercises to emphasize a "brain change." The program helps raise awareness of what optimal movement feels like to address rigidity, slow movement, poor coordination and other cognitive aspects of Parkinson's disease.

With repeated practice, patients learn the amount of effort required to produce normal movements, something that is significantly impaired in those with Parkinson's disease.

"It's not just about going through the movements," Singh says. "We always ask patients 'Are you pushing yourself to the maximum movement to do this action?' We make exercises meaningful and rewarding by tying them to personal goals, such as getting out of a low chair, getting out of a car or turning in bed."

After completing therapy, patients are encouraged to continue these exercises at home and to incorporate the concepts into their everyday activities. They are also asked to return for a checkup in a year or if they notice a significant change in their functional mobility.

According to Singh, many patients come to Sharp Grossmont's Rehabilitation Center knowing very little about Parkinson's disease. "We strive to educate each individual on their condition, as well as their role in reducing its effect on their daily lives. Our goal is for each patient to leave our facility feeling empowered, willing and able to make lifestyle changes that enable them to live the best life possible."